Autism spectrum disorder burden across 798 locations, 1990–2023: frontier and inequality mapping in the context of child injury prevention and safety promotion

Abstract

Autism spectrum disorder (ASD) is commonly identified in childhood and can affect communication, adaptive functioning, supervision, and access to health and educational services. These needs may be relevant to child safety planning, but this study did not measure injury outcomes. We analyzed Global Burden of Disease 1990–2023 estimates of ASD incidence and disability-adjusted life-year (DALY) rates across 798 locations. Age-standardized and under-20 rates were benchmarked against a Socio-demographic Index-related frontier using free disposal hull analysis. Socioeconomic inequalities were assessed using the slope index of inequality and concentration index. In 2023, 98 countries and territories (48.0%) were classified as behind the age-standardized incidence frontier and 78 (38.2%) as behind the age-standardized DALY frontier. Among individuals younger than 20 years, 100 (49.0%) were behind the incidence frontier and 123 (60.2%) were behind the DALY frontier. Frontier deviation increased in most countries between 1990 and 2023. Sweden had the largest reduction across all four national metrics, whereas Japan had the largest increase. Japan also had the largest 2023 deviations for age-standardized incidence, age-standardized DALYs, and under-20 DALYs; Brunei Darussalam had the largest under-20 incidence deviation. Selected Japanese prefectures were prominent subnational outliers, while locations in Pakistan and Nigeria showed the largest reductions. Recorded under-20 DALY burden became more concentrated in higher-SDI populations globally, whereas disadvantaged populations within low-SDI settings retained substantial absolute inequality. These findings provide descriptive benchmarks for ASD surveillance, early recognition, service organization, and equitable healthcare planning. They should not be interpreted as direct measures of service quality, unmet need, or injury risk.